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General NPI Number Information
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NPI Number | 1952374761
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Entity Type | Individual
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Provider Name | MARK SCOTT ERICSON DDS
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 1320 APPLE AVE STE 104
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City | HAYWARD
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State | CA
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Zip | 94541-1552
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Country | US
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Telephone | 360-870-9097
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Fax | 510-582-8147
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Provider Business Mailing Address
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Address Line | 1320 APPLE AVE STE 104
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City | HAYWARD
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State | CA
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Zip | 94541-1552
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Country | US
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Telephone | 360-870-9097
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Fax | 510-582-8147
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI02230300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 23691
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 60084
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License Number State | CA
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